:00:08. > :00:14.Welcome to the Temple of Peace and health in Cardiff. We are joined by
:00:14. > :00:19.people working on the front line in the NHS. There are patients and
:00:19. > :00:23.politicians here as well. One thing they all agree on is the fact that
:00:24. > :00:28.without the NHS we would be lost. It is saving and changing lives every
:00:28. > :00:32.day, but when things go wrong, our lessons being learned? And how
:00:32. > :00:48.honest I be about the state of the service? -- how honest are we?
:00:48. > :00:53.We have seen record cuts, rising waiting lists, and damning reports
:00:53. > :00:57.that show patients are dying whilst waiting for treatment. In parts of
:00:57. > :01:02.Wales, things are so bad that we are told that doctors do not want to
:01:02. > :01:06.work there. The big question is, why is this happening, and when there
:01:06. > :01:11.are failings, are people too afraid to speak out? We have seen Betsi
:01:11. > :01:15.Cadwaladr in the headlines again with calls for a corporate
:01:15. > :01:23.manslaughter and host investigation about the outbreak of C diff. Some
:01:23. > :01:30.say that too many people are being failed because the system is
:01:30. > :01:34.gridlocked. We asked the Health Minister to join us for tonight's
:01:34. > :01:40.debate, but he refused. No one from Welsh Labour wanted to take part.
:01:40. > :01:47.But this is what Mark Drakeford had to say about the NHS when we spoke
:01:47. > :01:51.to him last week. Demand is raising your own year and last winter the
:01:51. > :01:55.real pressure is on the NHS came from people aged 85 and above being
:01:55. > :02:00.admitted through error and emergency departments. We have worked really
:02:00. > :02:03.hard over the summer with our colleagues to try to make sure that
:02:03. > :02:10.the coming winter is not like the last one. The Welsh health service
:02:10. > :02:14.remains the truest of any of the other four -- of any of the four
:02:14. > :02:19.offending nations to the principles of Bevan. We are determined on
:02:19. > :02:23.wheels to continue to provide a National Health Service that his
:02:23. > :02:32.planned and provided on the basis of clinical need. -- in Wales.. That is
:02:32. > :02:35.the sort of service that they note in Wales. They will continue to
:02:35. > :02:44.receive. Ann Clwyd will want the Minister --
:02:44. > :02:49.warned the Minister not to bury his head in the sand. She warned that
:02:49. > :03:01.bed and would be turning in his grave. You are surging, is Ann Clwyd
:03:01. > :03:06.right? My natural inclination is to give reassurance. We have a lot of
:03:06. > :03:14.highly talented clinicians who are working very hard but another
:03:14. > :03:18.service that is under duress. We have CVS and genuine concerns.
:03:18. > :03:23.People are working hard, I could hear about in there, what is that?
:03:23. > :03:27.The organisation and the way that the system works does not always
:03:27. > :03:31.work in our favour in getting our patient's treatment in the time
:03:31. > :03:36.frame in which we would like them to have it. In particular, patients who
:03:37. > :03:45.have urgent or a life-threatening conditions do not make it on to a
:03:45. > :03:49.timescale target. These are the patients who are most at risk in
:03:49. > :03:56.many ways. Are people dying on waiting lists? It is very difficult
:03:56. > :03:59.to be certain of that, but we have some details from the cardiac
:03:59. > :04:05.surgery waiting list that people are coming to harm in Wales, which does
:04:05. > :04:24.not seem to happen in the rest of the UK. There is a suggestion that
:04:24. > :04:26.outcomes in Wales. . What is arguably union members telling you
:04:26. > :04:36.about the stresses and strains upon them? We hear it day in, day out.
:04:36. > :04:44.Short-staffed, stressed, sickness levels. Vacancy management, which
:04:44. > :04:59.means unfilled posts and so on. But what I would say, is that I work
:04:59. > :05:05.with the Welsh government and NHS Wales. The government is facing
:05:05. > :05:09.unprecedented cuts that the Welsh government has had to face in the
:05:09. > :05:14.past. What are members do understand is that the pressures have not been
:05:14. > :05:20.brought up on the Welsh NHS by Welsh government, but by the UK coalition
:05:20. > :05:25.government that is funding the Welsh government, and that cut in funding
:05:25. > :05:33.to wheels is passed on to the Welsh government and the NHS in Wales. But
:05:33. > :05:42.it is Welsh Labour that is managing the NHS in Wales. Correct? Yes, but
:05:42. > :05:46.they can only manage the cake that has been given to them. It is only
:05:46. > :05:51.so big and it has shrunk your own year. It will continue to shrink if
:05:52. > :06:01.the current Administration continues to fund Welsh government in the way
:06:01. > :06:04.that it is. Unison, you are claiming London. They give you the money and
:06:04. > :06:10.it is up to Labour in Wales to decide how much of that cake is
:06:10. > :06:14.divided? Absolutely. Oliver members on the front line are finding it
:06:14. > :06:19.tough, no one is going to run away from that. Those are the discussions
:06:19. > :06:24.that we have to have day in day out. Nobody is running away from
:06:25. > :06:29.that difficulty, but we also understand without difficulty
:06:29. > :06:34.emanates from. How often are people telling you, as the union wreck, I
:06:34. > :06:44.cannot do this. I cannot live at the service that I am being asked to do?
:06:44. > :06:48.All of the time. What we have is a front-line service that is under
:06:48. > :06:53.enormous pressure. Probably the greatest pressure that we have ever
:06:53. > :07:01.seen in Wales. I think back to the halcyon days, if you like, when we
:07:01. > :07:09.had unprecedented investment and funding in the NHS and will Wales --
:07:09. > :07:13.NHS in Wales. I never had any of those concerns raised with me and my
:07:13. > :07:22.colleagues in those days. This is a new phenomenon that we are dealing
:07:22. > :07:30.with. You are nurse, you are working on the front line. Does that
:07:30. > :07:33.register with you? Yes, it does. What is it like being on the front
:07:33. > :07:37.line and trying to deal with the never-ending tide of people coming
:07:37. > :07:46.through the front door, expending the best of care. -- expecting. I
:07:47. > :07:52.you able to cope? It is depressing. Some staff say that there is not
:07:52. > :07:57.enough hours in the day to complete the paperwork, never mind do the
:07:57. > :08:04.job. What I am seeing particularly in my brand of nursing, is that
:08:04. > :08:11.patients are stuck with this for ages, because the resources are not
:08:11. > :08:17.out there in the community for patients to be discharged. So our
:08:17. > :08:32.work becomes complex and confused by that factor. Morality is low? Yes,
:08:32. > :08:42.indeed. Not an exaggeration. Thank you for coming here tonight. Can you
:08:42. > :08:48.tell us how old you are? 80. And are you now almost completely blind?
:08:48. > :08:53.Yes. How long did you have to wait for treatment that you did not
:08:53. > :08:58.receive? 84 days for the first appointment and another five weeks
:08:58. > :09:05.before I had an injection. So you went blind waiting for treatment?
:09:05. > :09:12.Yes. So those people who manage those waiting lists, can you tell us
:09:12. > :09:19.what your life is like now? I cannot read, I cannot do anything. I cannot
:09:19. > :09:29.read my music, play the keyboard, my guitar. It is all gone. Why? Do you
:09:29. > :09:35.feel any bitterness? I do. There was no need for it. Two opticians signed
:09:35. > :09:53.the forms the day I went there to say that my I was bleeding. -- eye.
:09:53. > :10:04.They would not accept them. You are GP. GPs are also facing hefty
:10:04. > :10:09.workload. The workload for GPs has gone up by 50% in the last ten
:10:09. > :10:13.years. People are consulting is much more often, they tend to be older,
:10:13. > :10:20.they tend to have much more complex problems. They are expectations are
:10:20. > :10:27.higher. Are debuting out? Do they want to leave the job that they have
:10:27. > :10:33.given so much of their lives to do? I have heard of areas in Wales where
:10:33. > :10:38.doctors will not go and work. There are areas where there are
:10:38. > :10:42.difficulties recruiting GPs. I do not know whether it is to do with
:10:42. > :10:48.the nature of the job, what we're hearing from from young doctors is
:10:48. > :10:54.that there is concern for their families not having access to jobs.
:10:54. > :11:02.Maybe they do not like rural areas. Speaking to my colleagues, morale is
:11:02. > :11:08.lower than it has been for a long time. Bureaucracy is high,
:11:08. > :11:15.expectation is high. You are representing the help with
:11:15. > :11:20.management in Wales. What can you say to Mr Lewis, who went blind
:11:20. > :11:25.because the waiting list was so long that that was allowed to happen? I
:11:25. > :11:31.am so sad that you had that experience. It is true to say, and
:11:31. > :11:37.we have heard tonight already, that the NHS does not get it right all
:11:37. > :11:42.the time. Patients should be able to expect a certain level of care and
:11:42. > :11:45.treatment. They should be able to expect safe and quality treatment
:11:45. > :11:54.and respect when they are receiving that treatment. It makes me very sad
:11:54. > :11:58.and my members at the NHS Welsh Confederation very sad to hear
:11:58. > :12:05.this. What is at the heart of this? Is it incompetent management and is
:12:05. > :12:09.that at the heart of the problem? What this underlines very clearly is
:12:09. > :12:15.that the NHS in Wales needs to change. It is under unprecedented
:12:15. > :12:19.pressure. There are 70,000 members of staff directly employed who, we
:12:19. > :12:26.have already heard, are feeling under pressure. If we are to support
:12:26. > :12:32.them and help them with their morale, we need to demonstrate that
:12:32. > :12:42.the NHS must move its services. You are Conservative MP from North
:12:42. > :12:47.Wales. We have already heard that morale is low. There have been some
:12:47. > :12:54.major problems. But we have also heard, some people seeing here, our
:12:54. > :12:56.resources are being starved. It is the Westminster Government, they are
:12:56. > :13:06.not listening. They are not giving us the money that we need to get the
:13:06. > :13:13.job done. The reality is spending is increasing and Wales get the funding
:13:13. > :13:18.to do the same. It is all about the lack of priority. They manage to
:13:19. > :13:25.find £52 million burning a hole in a unplanned expenditure in
:13:25. > :13:31.nationalising and airport at a time when the NHS was at its most
:13:32. > :13:36.critical time, when thousands were having operations cancelled. That is
:13:36. > :13:43.all about priorities and the Welsh Labour government has got it wrong.
:13:43. > :13:48.Kirsty Williams, you are a Lib Dem. You show government with the
:13:48. > :13:55.Conservatives. On their arguments about the share of this cake and the
:13:55. > :14:00.way it is being shared out? We would like to see the way money flows
:14:00. > :14:08.changed but ring fencing budgets means the money coming down for NHS
:14:08. > :14:12.services in the ring fenced. When we are spending 40% of the Welsh budget
:14:12. > :14:17.on the health service, we are spending more per head on health
:14:17. > :14:24.services across the border, why are the outcomes worse? Why have we got
:14:24. > :14:28.a government that does not acknowledge the difficulties the
:14:28. > :14:33.service is facing and start listening to front line members of
:14:33. > :14:39.staff who often have the solutions to some of these problems. Why are
:14:39. > :14:44.we not listening to them and why are we not joining up services so the
:14:44. > :14:53.resources we have got are used appropriately? I met a family member
:14:53. > :15:03.whose relative is languishing on a hospital ward. Elin Jones, one of
:15:03. > :15:07.your MPs has called for a manslaughter enquiry today. I can
:15:07. > :15:17.hear a lot of politics going on here. This is a difficult thing to
:15:17. > :15:22.get right. Isn't it easy to sit on the opposition benches? No it is
:15:22. > :15:28.not, especially when you hear the first Minister question how great
:15:28. > :15:36.things are in the Welsh NHS and pick a fight with the UK government, pass
:15:36. > :15:43.blame on. We have to stop this blame game and it works both ways. We have
:15:43. > :15:48.to have responsibility taken for the Welsh NHS. It is a scandal
:15:48. > :15:54.politicians are not here tonight. They should be here and they should
:15:54. > :16:00.be taking responsibility. Let's talk about care. You are the older
:16:00. > :16:04.Persons Commissioner in Wales and published a report that said you are
:16:04. > :16:12.not happy with the way older people are treated in hospital. Just
:16:12. > :16:23.summarise the key issues. The average age of patients is over 80.
:16:23. > :16:26.My report looked at 12 areas. There was improvement across Wales and
:16:26. > :16:36.there was a lot of activity going on, but there is still a long way to
:16:36. > :16:43.go. Not getting the basics right for older people in hospitals, care for
:16:43. > :16:47.people with dementia and basic communication for people. Do you
:16:47. > :16:54.have an issue with the way people are looked after? Aren't they all
:16:54. > :17:04.Angels and what is the experience for some elderly people in hospital?
:17:04. > :17:10.Elderly people tell me how extant in -- outstanding their care has been
:17:10. > :17:15.and I do not want elderly people to go into hospital because for many
:17:15. > :17:21.their care will be great but they also tell me how we failed to get
:17:21. > :17:29.the basics right. Martin, you are from the Royal College of nursing.
:17:29. > :17:34.Not everybody gets it right. We have seen some of that evidence from the
:17:34. > :17:38.film and the people in this room. When you have the appropriate number
:17:38. > :17:44.of resources, outcomes are definitely better. One of the
:17:44. > :17:49.challenges is that people who work in the health service get up, do a
:17:49. > :17:58.good job when frequently they cannot do that good job, morale drops and
:17:58. > :18:01.we have evidence since 2011, 30% of people in the service said morale
:18:01. > :18:09.was so low they fight like leaving the service. This year this has gone
:18:09. > :18:14.to 60%. The impact of not doing your job properly does have an impact on
:18:14. > :18:19.patients and those delivering the service. Peter Walsh, you have
:18:19. > :18:26.published a report today in which you said that it was a shocking
:18:26. > :18:33.report, showing health boards across Wales are not listening to the
:18:33. > :18:39.warnings about patient safety. This was the third time we published this
:18:39. > :18:43.research. Each time there has been a worrying lack of implementation of
:18:43. > :18:47.patient safety alerts. These are life and death actions designed to
:18:47. > :18:54.protect patients from things that commonly go wrong and killed and
:18:54. > :18:59.seriously harm people. This year there was an increase in compliance
:18:59. > :19:03.but there were two health boards with multiple numbers of which
:19:03. > :19:08.alerts that they had not implemented, 15 of them going past
:19:08. > :19:16.the deadline that was said and health Inspectorate Wales could not
:19:16. > :19:24.provide one shred of evidence that they had taken any serious action.
:19:24. > :19:30.We have the chief executive of the health Inspectorate of Wales. Where
:19:30. > :19:35.have you been throughout all this? The point I would make to the
:19:35. > :19:40.patient safety alerts is we have been following up, we build those
:19:40. > :19:48.through into the inspections we undertake. The issue we find is one
:19:48. > :19:52.of consistency. Things can be done very well in one part of a
:19:52. > :19:58.particular health board and yet that learning is not consistently spread.
:19:58. > :20:02.That is an issue that needs to be followed through by each of the
:20:02. > :20:09.organisations, to make sure these things are picked up and implemented
:20:09. > :20:13.consistently. How can it be left over five years and for the
:20:13. > :20:18.regulator not to be able to evidence they have given a warning to one of
:20:18. > :20:25.these health boards about things that are designed to save people's
:20:26. > :20:32.lives? We have fed back on these as part of our reviews. We have not fed
:20:32. > :20:37.back on them explicitly in the context of patient safety alerts and
:20:37. > :20:49.that is one of the areas of learning we would want to take away. Let's
:20:49. > :20:55.turn to our opinion poll which we commissioned across Wales and it
:20:55. > :21:00.asked 750 people how confident they are that they will receive a good
:21:00. > :21:09.standard of care in the Welsh NHS? It turns out 72% said they were
:21:09. > :21:17.confident. But more than a quarter, 25% said they were not. You are
:21:17. > :21:23.happy, aren't you, with the service you have been getting? My wife
:21:23. > :21:29.suffered with chest pain back in August and I took her down to the
:21:29. > :21:34.accident and emergency department, triage saw her straightaway, they
:21:34. > :21:39.took her into the accident and emergency department. It seemed as
:21:39. > :21:49.though they will all concentrating on Heather. Kind people doing a good
:21:49. > :21:54.job? yes, there was a nurse reassuring us at all times,
:21:54. > :21:58.communicating well. The doctors telling us the results of the blood
:21:58. > :22:06.tests, they then kept her in because they thought she had a heart attack
:22:06. > :22:12.and again the care, the doctors... He wanted to say it is not all bad
:22:12. > :22:19.out there. There are lots of people in the NHS who care about people. I
:22:20. > :22:28.think so. We get these horror stories... If it was all the same.
:22:28. > :22:37.Unfortunately, there has been a 290% increase in complaints about our
:22:37. > :22:42.service in the Welsh NHS. One of the key problems is, it takes too long
:22:42. > :22:47.to get a response to a complaint. You complain and it can be months,
:22:47. > :22:55.years sometimes before the system response. Dorothy Wilson, you
:22:55. > :23:05.complained, didn't you? After your partner died. Yes, I did. How did
:23:05. > :23:11.you get on with your complaint? I try to do it on my own, try to find
:23:11. > :23:15.out what had happened. When I moved on from that and wanted to know why
:23:15. > :23:22.things had gone wrong, that was when the health board and the Trust
:23:22. > :23:27.actually turned against me and it became very bitter. Were you
:23:27. > :23:35.distressed, unhappy, frustrated at the? I am afraid it was much worse
:23:35. > :23:41.than that. I was grieving for a partner I had lost but on top of
:23:41. > :23:47.that, to be treated in the way I was, it pushed me to the limit. As a
:23:47. > :23:56.lawyer you deal with a lot of complaints. It is a typical story.
:23:56. > :24:03.We are currently dealing with 160 complaints. The timescales that the
:24:03. > :24:09.government, the Welsh government legislation has put in place, the
:24:09. > :24:15.timescale targets were in exceptional circumstances up to six
:24:15. > :24:20.months. It should be a 30 day response. None of our complaints
:24:20. > :24:27.have been within a six-month period. We have received that 72% of people
:24:27. > :24:32.said they are broadly happy with the system as it is working, so we have
:24:32. > :24:40.to remind ourselves of that, that it is not all dysfunctional and that
:24:40. > :24:44.would be a distortion to say that. Absolutely. I only see the cases of
:24:45. > :24:52.people who come to me with grievances. When the outcomes are
:24:52. > :24:57.poor... The signposting has improved in relation to advising patients
:24:57. > :25:10.where they need to go if they do have a complaint. 72% of people said
:25:10. > :25:13.they do not know where to complain. I think it has improved
:25:14. > :25:21.significantly since the previous procedure, however, I have a concern
:25:21. > :25:26.about the current procedure insofar as to aspects of it, the delays
:25:26. > :25:34.patients are experiencing and the independence of the procedure. It
:25:34. > :25:38.seems like a good point to bring in new, Julie Bailey, because you have
:25:38. > :25:45.been there as far as complaints are concerned. You are well known across
:25:45. > :25:48.the country for being the person who brought the major issues at mid
:25:48. > :25:57.Staffordshire to the nation's tension. But you prayed a price. --
:25:57. > :26:03.paid a price. Not everyone in your town was delighted by your
:26:03. > :26:08.response. From what you hear hear, is this all depressingly familiar
:26:08. > :26:15.and how do you go about complaining? Can you encourage
:26:15. > :26:21.people in any way? People contact me from all over the country and the
:26:21. > :26:27.first thing I tell them is the NHS complaints procedure is a torture.
:26:27. > :26:32.It is not the procedure itself, it is the people within it, the
:26:32. > :26:37.behaviours of the people within it. The NHS is renowned for denial, it's
:26:37. > :26:43.why your minister is not here tonight. They will not say there is
:26:43. > :26:47.a problem. We have not got that learning environment within the NHS.
:26:47. > :26:57.Complaints should be a rich source of information. Alan Birtwistle,
:26:57. > :27:03.there is a culture of denial. I know that NHS managers and leaders in
:27:03. > :27:07.Wales are working extremely hard to get an open and transparent culture
:27:07. > :27:13.and to be able to respond properly to complaints and learn lessons and
:27:13. > :27:19.really learn lessons is important, but what I would say is in our
:27:19. > :27:23.hospitals, surgeries and clinics, it is important that people are able to
:27:23. > :27:29.raise concerns as well as complaints. What we are talking
:27:29. > :27:35.about are some of the eager issues which clearly have to be addressed.
:27:35. > :27:43.We have to be really patient focused and patient centred. Professor, you
:27:43. > :27:48.listened very patiently and attentively to this. You had
:27:48. > :27:58.something to say in the phone earlier about the way the system is
:27:58. > :28:03.working. I am concerned about the complaints procedure in England. We
:28:03. > :28:08.had a good complaints procedure, there are about 14,000 complaints
:28:08. > :28:13.that are not resolved and had to go further. They were looked at by an
:28:13. > :28:20.independent panel. That panel was got rid of. It ended up in only one
:28:20. > :28:28.in the 375 complaints being properly investigated. That is very worrying.
:28:28. > :28:36.Professor, you lead the outbreak into the C diff -- investigation
:28:36. > :28:41.into the C diff outbreak. I you concerned about the culture of
:28:41. > :28:46.denial? I was concerned that they did not know what was going on. They
:28:46. > :28:50.were not denying, they did not know the figures that were on the wards.
:28:50. > :28:56.It was not going to the board itself. What about whistle-blowing?
:28:57. > :29:01.There had been an attempt by some of the infection-control staff. It took
:29:01. > :29:08.six months foreign emergency meeting to be held. From July to January.
:29:08. > :29:12.Should there be more whistle-blowing? Should we give
:29:12. > :29:18.people the protection to blow the whistle, in the interest of the
:29:18. > :29:25.patients and everyone else working? It has to go into the system and be
:29:25. > :29:29.acted upon very quickly. Some NHS staff have tried to do that and have
:29:29. > :29:33.been knocked back and knocked back by senior management and then in the
:29:33. > :29:39.end they give up and leave the organisation. When we tried to look
:29:39. > :29:44.at some of the figures, here in Cardiff we saw lots of cases that
:29:44. > :29:47.were not coded properly. We do not have the data to reassure ourselves
:29:47. > :29:50.that if something was going on then we would know about it, and if we
:29:50. > :30:05.did not abated that alarms would be raised. -- if we did know about it.
:30:06. > :30:11.We are not getting the truth out, it is your job as the inspectorate to
:30:11. > :30:14.get the truth out. We are part of the system which is responsible for
:30:14. > :30:23.providing assurance in the way that Enzo working. The health board are
:30:23. > :30:32.managing things themselves, then we go and test that things are
:30:32. > :30:38.happening correctly. What about whistle-blowers? Would that be
:30:38. > :30:41.helpful? There are already fossil blowing policies. I think that by
:30:41. > :30:46.the time you get to something which is called whistle-blowing it is
:30:46. > :30:49.possibly a step too late. I would like to think that we develop a
:30:49. > :30:57.culture where people are raising concerns long before that. Can I
:30:57. > :31:02.just ask you, we have spoken to some of the members of the BMA, which
:31:02. > :31:06.have told us some shocking stories and are far too nervous to come
:31:06. > :31:13.forward and speak. Is that a common experience? Welsh NHS employers have
:31:13. > :31:16.just been trying to introduce a whistle-blowing policy which till
:31:16. > :31:21.has a punitive element to it, rather than openness. We have had to
:31:21. > :31:30.campaign to maintain the free speech of doctors. Do they feel
:31:30. > :31:36.intimidated? Very much so. In terms of whistle-blowing, we had a staff
:31:36. > :31:41.survey recently amongst NHS staff in Wales, and it showed that staff are
:31:41. > :31:45.more inclined to be open and to report complaints and concerns than
:31:45. > :31:49.they ever have been in the past. So that kind of cultural thing that you
:31:49. > :31:55.are talking about is not there yet, but it is living in the right
:31:55. > :31:58.direction. In terms of the whistle-blowing policy, it is an
:31:58. > :32:04.interim policy at the moment which is being reviewed with a view to
:32:04. > :32:11.taking on board... I have to interrupt, where either
:32:11. > :32:14.whistle-blowers? There is a clear indication from the staff survey
:32:14. > :32:20.that people are prepared to come forward. They say they will, but I
:32:20. > :32:25.be doing it? They say that they will. The policy that we have at the
:32:25. > :32:29.moment is an interim one which will be reviewed in March to take on
:32:29. > :32:34.board the issues that came out of the Mid Staffordshire inquiry. I
:32:34. > :32:40.have to go back to you, we do not have a government minister to
:32:40. > :32:45.respond to this. This issue of whistle-blowing. People in many
:32:45. > :32:52.cases blow the whistle because they care and because they want things to
:32:52. > :32:56.work. Do you accept that we have to back off a bit, because there are
:32:56. > :33:01.suggestions that the culture is too oppressive and allow people to play
:33:01. > :33:08.a more active role in running their own NHS? I would want to challenge
:33:08. > :33:13.the idea that it is oppressive. There is a move towards more
:33:13. > :33:17.transparency. I would agree that by the time it gets to
:33:18. > :33:22.whistle-blowing, and whistle-blowers should be treated properly and be
:33:22. > :33:26.supported, actually, because we should use complaints of any sort at
:33:26. > :33:32.any level as an opportunity to improve services. That is the point
:33:32. > :33:38.that the professor wanted to make, complaints can be useful. System
:33:38. > :33:48.should be in place to monitor patient safety, standards of case,
:33:48. > :33:58.-- carer, infection rates. Loan from complaints. I would agree with that.
:33:58. > :34:02.If all of this information was available to the public, rather than
:34:03. > :34:07.head and in papers are only available after Freedom of
:34:07. > :34:14.Information request, then all of this information on mortality rates
:34:14. > :34:18.and infection rates being available with mean that people could see how
:34:18. > :34:23.things were improving or what needed to be done. There is a lot of big
:34:24. > :34:26.news on the horizon for the NHS in Wales. We have been talking a lot
:34:27. > :34:36.about reconfiguration on the landscape. Hamish, you lead the
:34:36. > :34:41.case. You think that the case for change is a good thing? I think that
:34:41. > :34:49.the NHS in Wales, as it is across the UK and more widely, is in -- is
:34:49. > :34:56.under huge pressure. We have to change. The NHS has changed hugely
:34:56. > :35:01.in what we are trying to do over the last 50 years, but we have not
:35:01. > :35:06.changed much in the way that we try to do it. We have to change so that
:35:06. > :35:11.we provide better care. 300 clinicians did not get in the ring
:35:11. > :35:15.and come forward with a proposal for the new programme because they
:35:15. > :35:22.wanted to save money, they did it because they wanted to improve care
:35:22. > :35:28.and have better standards. Is change necessary? PS. But the staff in
:35:28. > :35:36.Battersea do care about their patients and they work extremely
:35:36. > :35:40.hard under extreme pressures. We see union members coming to us because
:35:40. > :35:45.they want to get the carer. They give exceptionally high carer, but
:35:45. > :35:50.when they see in the media the onslaught of complaints about them,
:35:50. > :35:55.they take it very personally. Is it the media's fault? Mistakes have
:35:56. > :36:01.been made, but the front line staff work extremely hard. There will be a
:36:01. > :36:05.lot of people cheering you right across Wales, because staff to work
:36:05. > :36:09.hard. What we are talking about tonight is how we can make the
:36:09. > :36:18.system work better. You are an economist, you cat health matters.
:36:18. > :36:26.-- you look at health matters. Is the ideal one of centralisation.
:36:26. > :36:33.That we cannot have the NHS that we are all used to on our doorstep for
:36:33. > :36:37.any more time. That we need to change the system? The system does
:36:37. > :36:42.need changed. We have heard enough evidence just in this room to change
:36:42. > :36:46.that. One thing which has not been mentioned as our own individual
:36:46. > :36:49.responsibility. Public health has not featured in this debate at all.
:36:49. > :36:55.There are some aspects of health that cannot be prevented. The NHS is
:36:55. > :36:59.there to fix the problem is there to fix the problems to which we as a
:36:59. > :37:03.population have caused. I think that our expectations as to what the NHS
:37:03. > :37:09.can do for us also need to change as a population. The system does need
:37:09. > :37:12.to change, it is completely fragmented. We have integrated
:37:12. > :37:17.health board in Wales and yet they are not integrated. We still talk
:37:17. > :37:23.about hospitals and we talk about primary care. There is a thought
:37:23. > :37:36.that this is all about the carer of the patient, the individual. The
:37:36. > :37:39.care of the patient. You have terminal cancer. There is a
:37:39. > :37:45.treatment that could help you. Tell us about that. It is called
:37:45. > :37:54.selective internal radiotherapy treatment. And it involves pitting
:37:54. > :38:00.radioactive series through the artery, into the liver, and the
:38:00. > :38:06.attack the cancer without actually touching the liver. It is expensive
:38:06. > :38:15.though. It is very expensive. And therefore they will not give it to
:38:15. > :38:25.you? They will not fund me. I have had to fund it myself at a cost of
:38:25. > :38:34.£18,000. Yearly savings? Yes. I have had to borrow money as well to fit
:38:34. > :38:38.the bill. What do you say to those at the top, to remind them about the
:38:38. > :38:44.patient? I feel that I have been kicked into touch. Is this NHS good
:38:44. > :38:50.enough, or do you want it to be better? I think that in my case the
:38:50. > :38:59.NHS could have gone partway to funding my treatment, even if they
:38:59. > :39:06.cannot do it all. We will stop beer and remained ourselves that there
:39:06. > :39:11.are many people who are looking for this NHS to work. This debate could
:39:11. > :39:14.go on night. We hope that it is as open and transparent as everyone
:39:14. > :39:20.agrees that it needs to be in the future. I would like to thank
:39:20. > :39:22.everyone here at the Temple of Peace, and to you for watching. Good
:39:22. > :39:27.night.